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Abstract

Introduction: We have previously reported racial disparities in rates of sudden cardiac death (SCD) with higher SCD burden in blacks. We performed a detailed evaluation of autopsy findings among black vs. white cases of SCD in a community-based study.

Hypothesis: We hypothesized that post-mortem evaluation would reveal racial differences in cardiac abnormalities among SCD cases.

Methods: As a component of an ongoing multiple-source community-based study of SCD in the northwest US (population approx. 1 million), a subset of cases had detailed postmortem evaluation performed by the medical examiner. For this analysis, patients of black or white race age ≥18 with internal autopsy (2002 - 2012) were included.

Results: Among 395 patients with autopsy-confirmed SCD, 30 were black (78% male, mean age 41.8 yrs) and 365 were white (73% male, mean age 46.5 years). Autopsy findings of fresh MI were not significantly different in blacks and whites (13% vs. 20%; p=0.38). Blacks were less likely than whites to have significant (≥50%) coronary artery stenosis (55% vs. 79%, p=0.009), to have stenosis of 75% or greater (36% vs. 67%, p=0.004), or to have findings of old MI (7% vs. 22%, p=0.04). Blacks were more likely to have hypertrophic cardiomyopathy (HCM: 13% vs. 5%, p=0.07).

Conclusions: Higher rates of SCD in blacks cannot be attributed to more significant coronary artery disease. However, HCM continues to have an impact on increased SCD in blacks.